Exploring Perceptions of the Ability of Student Nurses to Achieve Learning Outcomes in Community-Based Psychiatric Mental Health Clinical Settings

Abstract

The purpose of this qualitative descriptive study was to investigate how traditional undergraduate baccalaureate (BSN) student nurses and their faculty perceive students' ability to achieve learning outcomes in community-based psychiatric mental health (PMH) clinical settings. Studies have shown that 25% of American adults experience a diagnosable PMH problem each year, and that acute care medical-surgical nurses carry an average patient load of five to six persons. Traditionally, PMH clinical experiences occurred on inpatient units located in acute care hospitals or within psychiatric hospital settings. However, many schools are downsizing and even eliminating PMH clinical experiences in favor of those clinical sites providing more technically based skills. The National Council of State Boards of Nursing also has decreased the psychosocial content on state boards to as little as 6% (2010). Additionally, many schools are moving much of the PMH clinical experience to community-based settings. This move to the community mirrors that of present and future employment opportunities for nurses, and statistics provide evidence that all nurses need PMH skills in order to meet the complex needs of their patients. However, there is no evidence as to what students are learning in these more diverse community-based settings. The research questions for the study included: 1) What are student nurses' perceptions of their ability to achieve learning outcomes in community-based PMH clinical settings? 2) What are faculty's perceptions' of the students' ability to achieve learning outcomes in community-based PMH clinical settings? 3) What are student nurses' perceptions of their ability to transfer knowledge gained in their community-based PMH clinical experiences to other healthcare settings? The sample consisted of 42 students and four faculty members from two Midwestern universities, with one faculty member from each school serving as a key informant, assisting the researcher with identification of possible participants and providing additional information useful in understanding the phenomenon. Students were given the option of completing questionnaires online or per paper/pencil. Faculty was encouraged to complete interviews, while given the option of completing an online questionnaire in lieu of the interview. Four self-selecting participants from the student group also participated in an online focus group as a means of member checking, as well as three faculty members participating in individual member checking. Content analysis was completed with responses by students and faculty to the open-ended questionnaire and interview items, as well as their responses during the online focus groups and/or individual member checking. Simple demographics were used to describe the sample. Corroboration of data from campus visits and artifacts was also included and used to provide a richer, thicker description of the phenomenon. The findings from this study showed that student nurses and their faculty perceived that students were able to achieve learning outcomes in the majority of PMH nursing skills through experiences provided in community-based PMH clinical settings. Three student themes emerged from the data: meeting the challenges of developing PMH nursing skills, sharing multiple experiences of feeling competent and empowering all nurses through PMH nursing skills. Three themes also emerged from the faculty data: seizing the day(s), sharing the road to competency, and empowering students in all areas of nursing. Two surprising, yet important findings were that even though most students felt competent with most PMH skills, the few students who did not perceive themselves as achieving the majority of PMH learning outcomes, felt that the experience was worthwhile and valuable. Most students also strongly felt that the PMH experience was important and that it they could and did apply the PMH skills they learned in all nursing practice areas.